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Case 3
Ms T. T., 33 yrs old: rheumatoid arthritis, migraine and gastritis

Ms T., an immigrant from Macedonia, has been suffering from gastritis for four
years, with severe pains when she has an empty stomach. Due to the suspicion of
ulcus ventriculi, she has twice had gastroscopy followed by treatment with a proton-
pump inhibitor (PPI), following which the stomach pains disappeared. At the same
time the migraine attacks (an existing condition) increased in frequency and
intensity, but returned to their previous level after stopping the PPI. 18 months ago
she began to suffer from rheumatoid arthritis which affected the knee and ankle
joints as well as the right elbow. The non-steroidal anti-rheumatic (NSAR)
medication prescribed for this again exacerbated the gastritis, which was treated
once more with a PPI. As expected, the headaches again increased. The patient
now hopes homeopathy can help her escape this vicious circle. The only additional
complaint she mentions is that she often suffers from colds and coughs.
Ms T. is a stocky and rather overweight patient with pale skin. She has slight
swelling and warmth in the affected joints, otherwise no pathological findings.
Despite our doubts about whether her German is adequate for us to communicate
well enough for homeopathic treatment, we decide to give it a try.

She prepares for the main casetaking by filling out the following questionnaires:

Musculoskeletal System rheumatoid arthritis

Gastrointestinal Tract gastritis
Neurology migraine
Additional Complaints tendency to infection and additional complaints
Background familial and work-related influences

During the main casetaking, we discuss every symptom that the patient has marked
on the questionnaire. After we have asked some additional questions, we create the
case log.
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Case log T. T.
T.T., 33 years old

Date of consultation

27.04.2009

27.05.2009

26.06.2009

07.08.2009

07.09.2009

12.10.2009

10.11.2009

21.12.2009

22.01.2010
Diagnosis, Frequency of DD/MM/YYYY (right)
Start of symptoms complaints Characteristic symptoms
(below)

Average symptom
6.3 5.0 2.7 1.7 1.3 0 0 0 0
intensity (scale 10-0)

Subjective improvement
0 5 7 7 8 10 10 10 10
(scale 0-10)

Rheumatoid Daily Sharp joint pain

Arthritis Bone pain
2008 < Change of weather
< Fatigue
< Initial movement
[< After waking up P] *
8 7 3 3 2 0 0 0 0
< After getting up from
bed P
[< Cold / > warmth P] **
> Lying [on side P ]***
> Rubbing P
[> Rest P] ****
Gastritis 3x per week Burning of inner parts
2005 < Empty stomach P
< Warm food P
< Sitting P
6 5 4 1 1 0 0 0 0
< Standing P
> Lying [on side P] ***
> Wrapping up warmly P
> Open air P *****

Key: < = worse, > = better, P = polar symptom

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Frequency Date of consultation

27.04.2009

27.05.2009

26.06.2009

07.08.2009

07.09.2009

12.10.2009

10.11.2009

21.12.2009

22.01.2010
Diagnosis, DD/MM/YYYY (right)
of
Start of symptoms
Characteristic symptoms
complaints
(below)

Migraine 1-2x per Hammering, pulsating

2004 week < Emotion
(< Stress)
< Light P
< Standing P
< Sitting P
< In room P ***** 5 3 1 1 1 0 0 0 0
< Fatigue
< Evening
> Movement P
> Lying [on side P] ***
[> Cold P ] **
> Pressure P

Clarification of the symptoms for the repertorisation

* Means: < after getting up from bed
** Contradictory symptoms, omit
*** The original symptom is clarified:
> lying becomes > lying on side
**** > Rest means: > lying (on side)
***** > in open air / < in room are rubrics with identical remedies.
The use of both symptoms does not lead to an incorrect remedy but it
artificially inflates the polarity difference. So we repertorise with only one of
these two symptoms. The same is true with, for example, < warmth / > cold
and < wrapping up / > uncovering.
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Repertorisation (Boenninghausen's Therapeutic Pocketbook 2000)

Key: < = worse, > = better, (P) = polar symptom, [80] = number of remedies matching the symptom
(e.g. < rising from bed, after getting up). CI = Contraindication. Remedies with contraindications are
shown with a grey background. See case 1 for the definition of a contraindication and how to
calculate the polarity difference.

Four remedies cover all symptoms but only Magnesium muriaticum has no
contraindications.

Remedy and Progress

The materia medica comparison shows that the remedy completely covers the
patient's typical symptoms. She is therefore given a dose of Magnesium muriaticum
200 C.
During the following month she herself decides to stop conventional medical
treatment. Her joint pains initially worsened but are now better, as is the heartburn.
And the headaches are markedly better. She rates the overall improvement at 50%,
which only appears realistic in view of the fact that she has stopped conventional
treatment. We continue with a dose of Magnesium muriaticum M.
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One month later Ms T. says that her joint pain and headaches are a lot better but the
heartburn is only a little better: total improvement 70%. She is so disturbed by the
stomach pains that we decide to seek another remedy. She marks the remaining
symptoms in the case log.

Rheumatoid Arthritis
Sharp joint pain
< Cold (P)
< After getting up from bed (P)
> Movement (P)
> Rubbing (P)
Gastritis
Burning of inner parts
< Empty stomach, before breakfast (P)
< Sitting (P)
< Standing (P)
< Warm food (P)
Migraine
Hammering, pulsating of inner parts
< In room (P)
< Light (P)
> External pressure (P)

(P) = polar symptoms

There are no new symptoms. Repertorisation uses only the polar symptoms.
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Repertorisation (Boenninghausen's Therapeutic Pocketbook 2000)

Key: < = worse, > = better, (P) = polar symptom, [90] = number of remedies matching the symptom
(e.g. < cold). CI = Contraindication. Remedies with contraindications are shown with a grey
background. See case 1 for the definition of a contraindication and how to calculate the polarity
difference.

Twelve remedies cover all symptoms. Only two have no contraindications:

Magnesium muriaticum (already prescribed) and Laurocerasus.

Remedy and Progress

The materia medica comparison shows that Laurocerasus also well fits the symptom
picture of this patient, so Ms T. is given a dose of Laurocerasus 200 C.
Four weeks later the stomach pains have noticeably improved but the migraine and
joint pains are still the same. Nevertheless the patient rates the overall improvement
as 65%, slightly lower than the last time. Since the progress graphic contradicts her
assessment, Laurocerasus is repeated in the potency M. One month later the joint
pains again improve but the stomach complaints and migraine remain roughly the
same. Overall improvement is 80%. A dose of Laurocerasus XM is given.
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This leads to the complete disappearance of all symptoms. At the next check-up, the
patient is beaming: I'm absolutely fine! This happy state of affairs persists through
subsequent check-ups. Period of observation: 4 years

Progress check, patient T.T.

Comments
It is surprising that the repertorisation for Ms T. indicated relatively minor
remedies. Since they worked so effectively, we can conclude that she
observed her symptoms accurately and was able to communicate them well
despite the language difficulties.
The vicious circle that the patient experienced with conventional medical
treatment was noticeable. This case is a perfect example of the advantages
of homeopathic treatment.